Provider Demographics
NPI:1619010113
Name:HARRISON UROLOGY CLINIC P.A.
Entity Type:Organization
Organization Name:HARRISON UROLOGY CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:FRAZIER
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-741-9481
Mailing Address - Street 1:324 WEST BOWER ST.
Mailing Address - Street 2:HARRISON UROLOGY CLINIC, P.A.
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601
Mailing Address - Country:US
Mailing Address - Phone:870-741-9481
Mailing Address - Fax:870-741-4614
Practice Address - Street 1:324 W BOWER AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3529
Practice Address - Country:US
Practice Address - Phone:870-741-9481
Practice Address - Fax:870-741-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-40262088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90182Medicare UPIN
AR57218Medicare ID - Type Unspecified